By Todd Molfenter, NIATx Deputy Director
One of the goals of the Patient Protection and Affordable
Care Act (ACA) is to lower the cost and improve the quality of care for
everyone. Behavioral healthcare providers may be uncertain about the future of
the legislation and what impact it will have. But the national trend toward fee-for-service
and managed care—which also aims to lower the costs and improve quality of care—is
requiring behavioral healthcare leaders to develop the same competencies
they’ll need to be fully prepared for the changes anticipated with healthcare
reform.
These competencies include understanding and implementing health
information technology (HIT), especially electronic health records (EHR) to
improve quality, contain costs, and give patients greater control of their
personal health.
Integration with primary care, another component of the ACA,
is already happening, as behavioral health works to operate in conjunction with
the broader health system. In the HealthReform Readiness Index survey administered by NIATx, the percentage of
behavioral health organizations that offer primary care increased from 6% to
15% from 2010 to 2012.
The movement toward managed care and fee-for-service
reimbursement has been accompanied by changes in state funding. Behavioral
healthcare providers are learning to expand their payer mix and their business
skills, developing new systems for billing, managing accounts receivables, and
reducing claim denials. Providers will need to have these systems firmly in
place to accommodate both the Medicaid expansion anticipated with ACA and the
Health Insurance Exchanges that will emerge—the new competitive markets that
will allow consumers to purchase affordable private insurance plans.
·
Enrollment: Changes in state funding are
requiring providers to help their patients determine their eligibility for
public or private insurance coverage.
Efficient enrollment systems will also be essential with Medicaid expansion
and HIEs.
·
Workforce development: Today’s changes in
funding and reimbursement are also driving the need for a workforce with the
credentials and clinical competence that payers require.
·
Using outcomes to influence clinical
decision-making: State governments and managed care increasingly require
documentation that demonstrates quality indicators are being tracked and a plan to continuously improve performance.
Whether or not the ACA is fully implemented as designed,
behavioral health care providers who are working on these areas are setting
themselves up for success in a funding environment that’s changing rapidly.
If you haven’t yet embarked on making the transition to this
new environment, or if you’re not sure where to begin, take a look the HealthReform Readiness Index (HRRI) that NIATx developed. It’s a quick (under 15
minutes) survey that will let you know immediately where you are on the
readiness spectrum. You might find that you’re in the early stages in one area,
but well on your way in another. The HRRI is just one of many tools that you
can use to help plan how to adapt your organization’s systems to the
transformation of the behavioral healthcare field.
